Epidemiology of Shoulder Dislocation Treated at Emergency Departments in the United States Between 1997 and 2021.

Background: The exact incidence of shoulder dislocation in the general population of the United States (US) has yet to be well studied. Purpose: To establish the current incidence and patterns of shoulder dislocations in the US, especially regarding sports-related activity. Study Design: Descriptive epidemiology study. Methods: This was a retrospective analysis of shoulder dislocations encountered in emergency departments in the US between 1997 and 2021 as recorded in the National Electronic Injury Surveillance System (NEISS). Data were further analyzed according to patient age, sex, and sports participation. Information from the United States Census Bureau was used to determine the overall incidence of dislocations. Results: A total of 46,855 shoulder dislocations were identified in the NEISS database, representing a national estimate of 1,915,975 dislocations (mean 25.2 per 100,000 person-years). The mean patient age was 35.3 years. More than half of the dislocations (52.5%) were sports-related, and basketball (16.4%), American football (15.6%), and cycling (9%) were the sports most commonly associated with dislocation. Most dislocations (72.1%) occurred in men. This disparity by sex was more significant for sports-related dislocations (86.1% in men) than nonsports-related dislocations (56.7% in men; P < .001). With sports-related dislocations, people <21 years experienced a significantly higher proportion versus those >39 years (44.6% vs 14.9%; P < .001), while the opposite distribution was seen with nonsports-related dislocations (<21 years: 12% vs >39 years: 51.7%; P < .001). Women outnumbered men with shoulder dislocation among people >61 years. Conclusion: Sports-related shoulder dislocations were more common among younger and male individuals than older and female individuals. Contact sports such as basketball and American football were associated with more shoulder dislocations compared with noncontact sports.

An Epidemiologic Comparison of Injuries to Skiers and Snowboarders Treated at United States Emergency Departments, 2000-2019.

Skiing and snowboarding are popular competitive and recreational sports that can be associated with significant injury. Previous studies of skiing and snowboarding injuries have been conducted, but studies evaluating injury types and patterns over long periods of time are needed to drive effective injury prevention efforts. We hypothesized that injury patterns would differ among snowboarders and skiers and that the number of injuries remained constant over time. This is a retrospective study of patients presenting with skiing or snowboarding injuries to the United States emergency departments from 2000 to 2019. A total of 34,720 injured skiers (48.0%) and snowboarders (52.0%) presented to US emergency departments over a 20-year period, representing an estimated 1,620,576 injuries nationwide. There is a decreasing trend of the number of injuries over the study period (p=0.012). Males represented the majority (65.7%) of injuries. Skiers were older than snowboarders (mean 30.1 vs. 20.0 years; p<0.001) and patients aged<18 represented more snowboarding (57.0%) than skiing (43.0%) injuries (p<0.001). Common diagnoses included fractures (33.0%) and sprains/strains (26.9%). Snowboarders primarily presented with upper extremity injuries, meanwhile, skiers primarily presented with lower extremity injuries. Most patients (93.2%), were treated and discharged from the emergency departments. Understanding the epidemiology of injuries presenting to emergency departments can help guide prehospital care and medical coverage allocation for resorts and event organizers, as well as identifying areas for targeted injury prevention efforts.

Epidemiology of hamstring injuries in 538 cases from an FC Barcelona multi sports club.

OBJECTIVES: Hamstring injuries are the most common muscle injuries in team sports. The aims of this study were to describe the epidemiology of hamstring muscle injuries in the professional and amateur sport sections of a multi-sport club Football Club Barcelona (FCB) and to determine any potential correlation between return-to-play (RTP) and injury location, severity of connective tissue damage, age, sex, and athlete's level of competition. METHODS: This descriptive epidemiological study with data collected from September 2007 to September 2017 stored in the FCB database. The study included non-contact hamstring injuries sustained during training or competition. RESULTS: A total of 538 hamstring injuries were reported in the club's database, of which 240 were structurally verified by imaging as hamstring injuries. The overall incidence for the 17 sports studied was 1.29 structurally verified hamstring injuries per 100 athletes per year. The muscle most commonly involved in hamstring injuries was the biceps femoris, and the connective tissue most frequently involved was the myofascial. There was no evidence of a statistically significant association between age and RTP after injury, and no statistically significant difference between sex and RTP. However, the time loss by professionals was shorter than for amateurs, and proximal hamstring injuries took longer RTP than distal ones. CONCLUSION: In the 17 sports practiced at multi-sport club, the incidence of hamstring injury was 1.29 per 100 athletes per year. Players from sports in which high-speed sprinting and kicking are necessary, and amateurs, were at higher risk of suffering a hamstring injury. In addition, proximally located hamstring injuries involving tendinous connective tissue showed the longest RTP time. Age did not seem to have any influence on RTP. Documenting location and the exact tissue involved in hamstring injuries may be beneficial for determining the prognosis and RTP.

Profound First-Degree Atrioventricular Block in a High-Level Basketball Athlete.

First-degree atrioventricular (AV) block (PR interval >200 ms) is commonly observed among screening electrocardiogram (ECG) in athletes. Profound first-degree AV block (PR interval >400 ms) and Mobitz type I (Wenckebach) second-degree AV block are generally uncommon and often require further workup on a case-by-case basis, particularly when there is concern for a structural cardiac abnormality. In this case, we present an example of an asymptomatic profound first-degree AV block with Mobitz type I (Wenckebach) second-degree AV block. Transthoracic echocardiogram and stress echocardiogram were unremarkable and the patient was cleared to participate in sports without any restriction. Physicians managing athletes should be aware of ECG features that require additional evaluation and cardiology consultation.

Non-operative Management of an Accidental Knee Intra-articular Nail.

Nail gun injuries are relatively common presentations to the emergency department. The majority of these injuries occur to the hands and rarely result in long-term morbidity. However, despite the large number of cases each year, little research is available regarding the optimum emergency management of nails that implant intra-articularly. Initial studies suggested that cases of nails penetrating intra-articular or neurovascular structures warranted operative debridement; however, newer studies have suggested cautious nail removal, wound debridement, irrigation, antibiotic coverage, and tetanus prophylaxis are equivalent to operative intervention for the management of most intra-articular nails. We present a gentleman in his 40s with accidental penetration of a nail fired from a nail gun into his right knee. He was neurovascularly intact. After initial evaluation and management, he was transported to a higher level of care for operative management. However, the nail was ultimately removed bedside utilizing adequate anesthesia.

Athletes With Attention-Deficit/Hyperactivity Disorder: Position Statement of the American Medical Society for Sports Medicine.

ABSTRACT: Athletes of all ages may be affected by medical and mental health issues. Sports medicine physicians should be familiar with common conditions that may affect the well-being of athletes, such as attention-deficit/hyperactivity disorder (ADHD). ADHD behaviors have the potential to affect a person's ability to concentrate. It is likely that social and cognitive therapies combined with pharmacotherapy will be the most effective way to treat ADHD in athletes. Medications used for ADHD, especially stimulant types, are known to improve alertness, reaction time, anaerobic performance, and endurance, which would potentially improve athletic performance. Furthermore, stimulant medications may enable student athletes with ADHD to focus on academic studies for longer periods of time, beyond usual levels of fatigue, important for those who may be exhausted after practices and games. The purported performance enhancement effects and potential adverse effects of stimulant medications have prompted many sports governing bodies to ban prescription stimulants or establish strict rules for their use. Athletes taking physician-prescribed stimulants to treat ADHD need to provide the appropriate documentation for approval before competition or risk punitive measures. Physicians should strive to provide a high quality of care to athletes with ADHD through early diagnosis, appropriate and careful multidisciplinary treatment, and complete and timely documentation to facilitate continued sports participation.

Pseudoaneurysm of the subclavian artery as a delayed complication of a clavicle fracture.

Vascular complications are relatively rare following surgical fixation of midshaft clavicle fractures. Here, we report a case of a woman in her 30s presenting 10 years after right clavicular open reduction and internal fixation with revision 6 years prior with sudden and rapidly progressive neck swelling. Physical examination revealed a soft pulsating mass in her right supraclavicular fossa. Ultrasound and CT angiography of the head and neck showed a pseudoaneurysm of her right subclavian artery with a surrounding haematoma. She was admitted to the vascular surgery team for endovascular repair with stenting. Postoperatively, she developed arterial thrombi requiring thrombectomy (twice) and is now on lifelong anticoagulation. It is crucial to be aware of complications that can develop in patients with a history of clavicular fracture managed non-operatively or operatively even years later and highlights the importance of risk and benefit discussions and counselling.

SalterHarris fractures in paediatric skiers and snowboarders.

The incidence of paediatric fractures among winter sport athletes is not adequately studied. Our objective was to categorize fractures that occurred in paediatric skiers and snowboarders at a single ski resort. X-rays of 756 skiers/snowboarders aged 3-17 diagnosed with a fracture were categorized using the Salter-Harris (SH) classification. SH fractures were seen in 158 (21%) patients, with 123 (77%) being Type II. There were no significant differences between patients with a SH fracture and patients with a non-SH fracture for age, sex, snowboarding or skiing, mechanism of injury, terrain or the resort conditions on the day of injury. The most common mechanism of injury was falling onto snow while collisions resulted in more severe injuries. Compared to fractures without growth plate involvement, a higher proportion of SH fractures were seen in the humerus, radius, fibula and thumb; a lower proportion of SH fractures were observed at the tibia and clavicle.

Acromioclavicular Joint Injuries in Sport.

ABSTRACT: Sport-related shoulder injuries, including disruptions to the acromioclavicular joint (ACJ), are common. An ACJ injury is classified by the degree and direction of the clavicle displacement. Although the diagnosis can be made clinically, standard radiographic views are important to determine the severity of the ACJ disruption and assess for concurrent injuries. The majority of ACJ injuries can be managed nonoperatively; however, surgical treatment is indicated in some cases. Long-term outcomes are generally favorable for most ACJ injuries, and athletes generally return to sport without functional limitations. This article provides an in-depth discussion regarding all aspects of ACJ injuries, including clinically relevant anatomy, biomechanics, evaluation, treatment, and complications.

Are Different Aged Youth Skiers and Snowboarders Experiencing Different Injury Characteristics?

INTRODUCTION: Skiing and snowboarding are popular winter sports with significant youth participation and inherent potential for injury. We investigated the relationship between age and injury characteristics exhibited by youth skiers and snowboarders. METHODS: In this cross-sectional study, we investigated injury characteristics among youth skiers and snowboarders at a ski resort, examining the association between age and injury type. We compared injury characteristics among young children (aged 3-6 y), school-aged children (aged 7-14 y), and older adolescents (aged 15-17 y) using χ2, and examined predictive variables for injuries at different anatomical locations using logistic regression. RESULTS: Compared with snowboarding, skiing was associated with greater odds of lower extremity (adjusted odds ratio [aOR]=6.8, 95% confidence interval [CI]: 4.89, 9.47, P<0.001) and head/face/neck (aOR=1.63, 95% CI: 1.20, 2.21, P=0.002) injuries. Compared with skiing, snowboarding was associated with greater odds of upper extremity injury (aOR=5.9, 95% CI: 4.6, 7.6, P<0.001). Age group significantly affected injury mechanism (χ2 [df=12, n=1129]=42.882, P<0.0001) and diagnosis (χ2 [df=12, n=1129]=43.093, P<0.0001). Young child skiers had the highest proportion of injuries to the head/neck/face and lower extremities and a significantly higher proportion of collision injuries and fractures than older skiers. Young child skiers most frequently injured the lower leg/ankle, while older skiers most frequently injured the knee. CONCLUSIONS: Youth skiers exhibited predominately lower extremity injuries, while snowboarders exhibited predominately upper extremity injuries. Age significantly affected injury mechanism and injury diagnosis in youth skiers. Specifically, younger skiers tended to suffer more fractures and collision injuries than older youth skiers.

Are Boosters Necessary If Adult Patients Do Not Achieve Seroconversion After 2 Doses of the MMR Vaccine?

The Centers for Disease Control (CDC) recommend 2 documented doses of the MMR (measles-mumps-rubella) vaccine for adequate measles, mumps, and rubella immunity for all children and most adults. Sometimes, individuals are asked to provide serologic proof of immunity to measles, mumps, and/or rubella for educational or employment purposes. In other instances, serologic testing may be used to help clarify whether an individual has immunity to measles, mumps, and/or rubella. These serologic tests may sometimes show negative or equivocal antibody titers to measles, mumps and/or rubella, raising the question of adequate immunity. This report provides practical guidance for clinicians on when to use serologic testing to determine measles, mumps, and rubella immunity.

Acromioclavicular joint injuries at a Colorado ski resort.

BACKGROUND: Acromioclavicular joint (ACJ) injuries are among the most common injuries in contact and non-contact sports. As winter sports become more popular, there has been an increase in shoulder injuries among recreational skiers and snowboarders. METHODS: This was a retrospective analysis of all patients who presented to the Denver Health Winter Park Medical Center with ACJ injury from 2012 to 2017. We examined the incidence of ACJ injuries, the injury mechanism, demographics, and type of ACJ injuries among skiers and snowboarders treated at the clinic. RESULTS: A total of 341 ACJ injuries (6.7% of total visits) were encountered during the study period. The majority of ACJ injures were type I (41.3%) and mainly occurred in men (86.5%). Most (96.8%) of the cases were primary ACJ injuries on the right shoulder (56.9%). The average age of patients with ACJ injuries was 30.0 years (range 10-72). More than half (62.2%) of ACJ injuries occurred while snowboarding. The most common mechanism of injury (93.5%) was fall to the snow while skiing/snowboarding. Women were more likely to have a type I ACJ injury than men (80.4% vs 35.4%; P < 0.001). Women with ACJ injuries were more likely to suffer the injury while skiing than snowboarding (71.7% vs 28.3%; P < 0.001), compared to men who were more likely to suffer the injury while snowboarding than skiing (67.5% vs 32.5%; P < 0.001). CONCLUSIONS: Most of the ACJ injuries were type I and occurred mostly in men. Snowboarders were more likely to have an ACJ injury than skiers. LEVEL OF EVIDENCE: Level IV, Epidemeiology Study.

Posterior Shoulder Pain and Muscle Wasting in an Older Adult.

Musculoskeletal injuries are among the most common chief complaints in the geriatric population. Shoulder pain with associated deformity should be evaluated for possible joint dislocations, fractures, and musculotendinous tears. A comprehensive evaluation beginning with history and physical examination is important. Typical imaging utilized for the diagnosis of shoulder injuries includes plain radiography, ultrasound, and magnetic resonance imaging (MRI). We present a case of a 75-year-old male with massive rotator cuff tears and subsequent shoulder deformity. Management with non-surgical or surgical approaches should begin as soon as possible to delay the development of rotator cuff arthropathy.

Glenohumeral Joint Dislocation Classification: Literature Review and Suggestion for a New Subtype.

ABSTRACT: Glenohumeral joint (GHJ) dislocation is a relatively common injury. Anterior GHJ dislocations are divided into subcoracoid, subglenoid, subclavicular, and intrathoracic subtypes. The aim of this article is to review current GHJ dislocation classification and briefly discuss management of each type. Discrepancies and inaccuracies exist in regard to GHJ dislocation classification. We suggest adding a new subtype, "paraglenoid," to improve the current GHJ dislocation classification system. The paraglenoid subtype describes a portion of the subcoracoid anterior GHJ dislocation. GHJ dislocation is most often caused by force applied to the arm during a fall but also can be due to direct impact to the shoulder. Physical examination often reveals classic deformities, and thorough neurovascular examination is crucial. Radiographs should be used to confirm the diagnosis and assess for associated bony injuries. Numerous reduction techniques are described in the literature, with chosen method dependent on patient factors, provider experience, and GHJ dislocation type.

Recommended Sports Medicine Fellowship Scholarly Activity Curriculum.

ABSTRACT: Scholarly activity requirements for primary care sports medicine fellowship programs are increasing and the current Accreditation Council for Graduate Medicine Education (ACGME) expectations for fellows and core faculty are more demanding than those found in medicine residencies. A review of existing literature fails to identify any published guidelines on how to pursue scholarly activity within the sports medicine fellowship year. Such a deficiency may be critical for fellowship programs that are struggling to produce scholarship with a 1-year timeframe. This document intends to be a resource for all sports medicine fellowship programs by defining acceptable pieces of scholarly activity, delineating how a project may be completed during fellowship, and outlining avenues to educate others in the topic of choice. Adoption of this curriculum will guide fellows to meet ACGME-mandated scholarship requirements while assisting core faculty in meeting academic promotion criteria.

Epidemiology of racket and paddle sports-related injuries treated in the United States emergency departments, 2007-2016.

OBJECTIVE: Racket and paddle sports are popular worldwide. Although there are several epidemiologic studies on tennis, there are limited epidemiologic studies on injuries in badminton, squash, racquetball, table tennis, pickleball and other racket and paddle sports. We aimed to analyze acute racket and paddle sports injuries that presented to emergency departments. DESIGN: Descriptive epidemiologic study; level of evidence 3. SETTING: United States emergency departments (USEDs). METHODS: Data from National Electronic Injury Surveillance System (NEISS) were queried to characterize racket and paddle sports-related (RPSR) injuries that presented to USEDs over a 10-year period. RESULTS: From 2007 to 2016, there were 7,723 cases of racket and paddle sports-related (RPSR) injuries that presented to USEDs. This data provides a weighted estimate of 301,038 RPSR injuries in USEDs over the 10-year study period. The majority (60.3) of these injuries were in men. Men had a higher percentage of injuries of most body parts except the lower arm, wrist, and ankle. The mean age at the time of injury was 37 years. The highest percentage of sprains, strains, and lower extremity injuries occurred in athletes between ages 18-40 years. Between sports, table tennis had highest percentage of skin and internal organ injuries while badminton had the highest percentage of sprains, strains, fractures, and dislocations. CONCLUSION: This study is the largest nationally representative study of RPSR injuries to date. RPSR injuries are varied in their presentation based on age, sex, body location, and type of injury. CLINICAL RELEVANCE: This study determined common RPSR injuries presenting to USEDs, their patterns, and severity over a 10-year period. Researchers and clinicians can begin to use this data for future research studies and may consider this early data in management decisions.